Software Solutions/EHR

Ready to Make the Switch? Why Transitioning to Cloud-Based EHR is Worth It

By Lorie Lippiatt, OD

Electronic health records that are “in the cloud” have compelling advantages. There are efficiencies, cost savings, ease of access–and it all adds up to better eyecare for the patient.

I’ve heard many people equate practice management and EHR software to the “brain” of a practice. It’s an interesting concept because while there are many other factors that keep a practice alive, the software does become central to the way the practice runs. We become accustomed to thinking of our practice and our processes in terms of how the software works because it’s our hub. We get to that point after investing in the solution, both financially and with our time. For most of us, it took a while to get both ourselves and our staff comfortable with the system.

I can relate to my colleagues who don’t even want to entertain the thought of changing from one system to another, much less go through with it. I deployed the industry’s leading practice management system in 1991, and I’ve been using its complementary EHR for over 10 years. For the first time, I’m ready to make a switch. I’ve been watching the technology landscape change, and I see the way that cloud-based technology is ushering in innovation that is like nothing our industry has seen before. I see my colleagues in other industries benefiting from it and I want it. It took a while to get here, but I think it was worth the wait. Here is my EHR story, and how and why I am transitioning to a new, cloud-based system.

Knowing It Might Be Time to Move to a New System

Our office has been practically paperless for over a decade, and frankly, this solution has worked well for our practice. Using the EHR/PMS solution in combination not only enabled us to become paperless, but also much more efficient and less staff-dependent. We were able to integrate Marco digital refraction systems, retinal photography, visual fields, OCT technology, Optos, anterior segment photography, and a document management system with our PMS/EHR solution, which defines our technology-integrated practice. We have enjoyed the conveniences of an automated telephony process for patient recall, automated patient notifications for product deliveries and auto-generated practice newsletter and patient birthday cards. I have literally spent the last 10+ years studying practice workflow, fine-tuning automated solutions and striving for efficiencies which result in profitability. We made significant progress, and document management was to be our “final frontier.” With this, we would become completely paperless. Using our integrated system, we have finally incorporated a sophisticated solution that has enabled the scanning and electronic filing of all paper documents, even our accounting needs.

You might be wondering, “OK, so you have it all, why would you change?” Well, what I hadn’t included in that explanation is the cost of maintaining these solutions “on the ground” through a client-server solution. It has become extensive. And I’m not just talking about the hardware and software costs. There are also the costs of redundancy (back-up solutions), both in man-hours and software and hardware costs, which are ever-increasing. Since we rely on data and technology for daily operations, we have incorporated multiple back-up solutions to reduce our risks. You better believe those have become expensive, especially as our digital data storage needs have increased.

Essentially, my needs have outgrown my technology. In order to keep up with my advanced practice, I simply need more from a practice management/EHR solution. And what I’ve learned is that what I need is not possible on the ground with a client-server software. In fact, I don’t just need another “software” at all; I need something more. Cloud-based solutions are going to give me that something more, so I know not only is it time to move, it’s time to move to the cloud.

Inconvenience, Software Upgrades, and Add-On Fees Really Add Up

As I said, the efficiencies described above related to our current software-based system certainly came with an associated cost. But did the benefits outweigh the costs? I wanted to know, so I took an honest look at all of the costs. The annual software maintenance fee is just a small part of the overall cost in maintaining a technology-oriented practice. Each business vendor we integrate with has their own monthly fee. When I “did the math”, and analyzed the soft costs like my time and staff time, as well as the annual fees and various fees I pay for add-on solutions (from a number of different companies), the overall total was staggering.

Next to cost, the most significant disadvantage of a client/server-based solution are the needed software upgrades. We have 38 workstations at our practice and we have to make sure everything is running the same version. The effort required to perform a software upgrade is considerable. Upgrades must be performed “off business hours,” and only after a backup has been performed. Once we’re backed up and ready to go, during those precious hours that we would otherwise be spending enjoying our lives, each workstation must be individually upgraded. Yes, individually upgraded. This takes a considerable amount of time and is expensive, especially if things don’t go smoothly.

Cloud-based technology handles these things for me. Upgrades happen automatically. Services are embedded, not just integrated. I get an inter-operable system that’s not only more accessible (now when I’m not doing those upgrades and I’m actually enjoying my free time, I can just pop online and access my data from my tablet device), but will actually improve the way my practice operates. The costs go down and my quality of life goes up.

Other Factors Driving My Decision to Switch to a Cloud-Based Solution

Now, cost is a big factor in any business decision, but it’s not the only factor. And I also didn’t just think about the inconveniences I could lose. I wanted to gain something too, so I was thinking about what a cloud-based solution could bring to the table that simply wasn’t there before. Specifically, I was looking for solutions to solve my need for the following:

• Improved inter-operability functionality
• Software updates to occur in a more frequent, seamless fashion
• Software to be more intuitive for new staff (decrease learning curve)
• The ability to access office data from post-PC devices, from any location
• Easier data back-up solutions
• Easier data entry

In addition to solving these needs, I discovered that there will be other important improvements–both for my practice and my patients. I made a list of what each of us stood to gain and I must say that I liked what I saw!

Here’s the List of Practice Improvements:
• Real-time billing coding edits, which will eliminate the errors associated with billing the wrong ICD/CPT combinations, or billing two incompatible CPT combinations the same day
• Incorporated lens and contact lens catalogs
• Improved patient communication capacity through the patient portal
• Ability to reduce hardware costs by using post-PC devices
• Less costs associated with data storage and maintenance
• Improved scheduler capability
• More secure system log-ins and tracking
• Reduced IT requirements/needs
• Elimination of in-house data back-up

And here’s the list of improvements my patients will experience:
• Ability for the patient to complete all necessary demographic, health history and lifestyle questionnaires via patient portal, thus eliminating time spent in the office
• Improved patient access to medical and optical records through the patient portal
• Improved patient access to educational material through the patient portal
• Improved patient care resultant from my ability to access patient records from any location

The patient factor was huge, as it should be! I believe patients expect and deserve a certain standard of care based on the available technologies that exist today. Further, patients are more acute in recognizing practitioners who deliver that type of care. I feel confident that by adopting the latest in cloud technology, it will be recognized by not only my patients, but by potential patients, and they will desire that standard of care as it relates to their eyecare needs.

In the Cloud, EHR Becomes Unrestricted, Interactive, Inter-Operable and Fluid
The EHR technology we are adopting is “unrestricted,” in the sense it is entirely customizable for our practice needs, it’s easier to use, and it’s affordable, whether you’re a new practice just starting out or one that’s robust with several locations and doctors. So, you aren’t restricted by functionality, usability or cost. The new cloud-based solution is “interactive” in the sense that patients can complete pertinent and relevant portions of their eye and health history, and family history and lifestyle needs, which my staff and I can review and easily incorporate into the medical record.

Further, the patient will have access to their medical and optical information through their secured portal. It’s “inter-operable” in the sense we will be able to exchange information directly from the EHR to other health professionals, PCP’s, HIE entities, etc. It’s “fluid” in the sense that our software updates will occur in a timely and seamless manner based on changes occurring in the health care arena. No longer will we have to wait months, for example, for a change that was made to a CPT code for it to show up in our software. I can’t say any of this for my legacy program. Now that I know a cloud-based technology will afford these things that legacy, client-server systems can’t, the decision is clear. Cloud is the way to go.

Set a Timetable for Implementation and Soothing Staff Concerns
Once I made a decision about what I was going to do, I had to determine when I could do it. The same is true for any business–you have to be realistic, but challenge yourself to make the change and commit to a timeframe so that it doesn’t get postponed. We are hoping to implement this brand new solution by the end of 2013.

Now that I had a timeframe, I had to prepare my staff. Essentially, I am telling them that if they can operate a “smartphone,” they should be easily able to make the transition to our new technology. (It’s really that much easier to use.) Happily, everyone in my office does own a smartphone. I chose new EHR technology with ease-of-use in mind. I thought about when I migrated from my Blackberry to an iPhone, then iPad, then Mac Air, and finally, iMac. I never once read a manual or used the tutorials. I’m not saying there is no need for that, but I am saying that if I have to take hours of classes to use a program, it’s probably not the choice I’m going to make. Not for my own mobile devices, and certainly not for the technology solution I put in place in my business.

Related ROB Articles

Cloud-Based Technology 101: Is Your Practice “In the Cloud” Yet?

Transition to EHR: Educate, Implement, Train…and Optimize

Get Stage 2 Meaningful Use-Ready: Incorporate Medical Imagery in EHR

Lorie Lippiatt, OD, is the founder of The Salem Eyecare Center, Inc., in Salem, Ohio. To contact her: LLLEYEDOC@aol.com.

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